MEDICARE: NICOLE SCHWEON LMHC CAP NCC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 8923	FL

General Provider Information

NPI Number	:	1518129832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE SCHWEON LMHC CAP NCC LLC

Provider Business Mailing Address
First Line	:	PO BOX 50518
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32240-0518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 3RD ST N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7238
Country	:	US
Telephone Number	:	561-632-5567
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	NICOLE SODERBERG
Credential	:
Telephone Number	:	561-632-5567

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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